Provider Demographics
NPI:1891816740
Name:MATARRESE, MARISSA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:RAE
Last Name:MATARRESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CLUB RD
Mailing Address - Street 2:#304
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-4919
Mailing Address - Country:US
Mailing Address - Phone:585-746-0413
Mailing Address - Fax:
Practice Address - Street 1:214 CORNELIA ST
Practice Address - Street 2:#103
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2306
Practice Address - Country:US
Practice Address - Phone:518-562-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268664-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery